ISSN 2996-8215
International Journal of Cardiology | Vol. 2, No. 12, December 2011 | pp. 89–96
DOI: 10.46882/2011/IJC/000033
Original Research Article
Effect of High-Dose Atorvastatin Reloading Before Percutaneous Coronary Intervention in Patients on Chronic Statin Therapy
Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²
¹Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
²Division of Cardiovascular Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
Abstract:
Preprocedural statin loading reduces perioperative myocardial infarction (pMI) in statin-naive patients undergoing percutaneous coronary intervention (PCI). However, the clinical value of acute high-dose statin reloading in patients already on chronic, maintenance statin therapy remains unestablished. This prospective, randomized, open-label trial evaluated whether a high-dose atorvastatin reload prior to PCI reduces pMI in patients established on chronic statin therapy. We enrolled 260 patients with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) on continuous statin therapy for greater than 30 days. Patients were randomized to receive either an acute reload of atorvastatin (80 mg administered 12 hours and 2 hours before PCI, n = 130) or to continue their standard maintenance dose (n = 130). The primary endpoint was the incidence of pMI, defined as an elevation of cardiac troponin I (cTnI) greater than 5 times the upper limit of normal within 24 hours post-PCI. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the control group (7.7% vs. 16.2%, p = 0.03). Mean post-procedural cTnI levels were also significantly lower in reloaded patients (0.42 ± 0.15 ng/mL vs. 0.88 ± 0.24 ng/mL, p < 0.01). No cases of acute hepatic dysfunction or rhabdomyolysis were observed in either cohort. High-dose atorvastatin reloading safely reduces the incidence of periprocedural myocardial injury and infarction in patients undergoing PCI, even when they are already established on chronic maintenance statin therapy.
Keywords: Percutaneous coronary intervention, Atorvastatin, Statin loading, Periprocedural myocardial infarction, Stable angina, Acute coronary syndrome
Received: September 05, 2011; Revised: October 20, 2011; Accepted: November 12, 2011; Published: December 18, 2011
Citation: International Journal of Cardiology, 2011, Vol. 2, No. 12, pp. 89–96, DOI: 10.46882/2011/IJC/000033